Yonder: Surgical site infection, opioid dependence, racial diversity, and Meals on Wheels (February 2024)

Ahmed Rashid is a GP and Professor of medical education at UCL medical school, He is on X: @Dr_A_Rashid

Surgical site infections (SSIs) are surprisingly common and are associated with a range of adverse patient outcomes, which can be reduced by implementing systematic surveillance systems. A recent Irish study sought to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals to SSI prevention and surveillance in a university hospital setting.1 A multidisciplinary implementation group consisted of surgeons, anaesthetists, theatre nurses, surveillance scientists, nurses, pharmacists, ward staff, clinical nurse specialists (colorectal surgery, stoma therapy, infection control), theatre managers, theatre staff, recovery staff, dietitians, occupational therapists, and physiotherapists. A care bundle was co-designed by this group, which included a 48-page booklet that guides patients on all aspects of their care from the decision to operate to returning home postoperatively. Perhaps unsurprisingly given the comprehensive nature of the intervention, it had an overall positive impact. Whether or not it can be translated to routine care, though, remains to be seen.

Surgical site infection, opioid dependence, racial diversity, and Meals on Wheels  

The diagnosis of opioid dependence during pregnancy has increased in recent years, prompting specialised, integrated and comprehensive services for pregnant women to be established across North America. A recent Canadian paper examined the social organisation of drug treatment supports for those who are pregnant, using Canadian clinical practice guidelines (CPGs) for methadone maintenance treatment (MMT) as a case study.2 It shows that guidelines address few treatment considerations for pregnant patients, other than improved birth outcomes and child welfare, despite acknowledging their more complex needs. The authors argue that MMT CPGs therefore perpetuate the intensified surveillance and foetal prioritisation that have long generated barriers to care for opiate-dependent pregnant patients. They also point out that poverty, homelessness and social isolation are inextricably linked and require further ‘concerted efforts’.

Due to structural and cultural discrimination, Black, Latinx, and Indigenous Americans have long been excluded or marginalized in health professions training and these disparities have important consequences for healthcare outcomes. Lack of representative diversity extends to rehabilitation professions, including physical therapy (PT), which is overwhelmingly white and able-bodied. A recent study from Nebraska examines the influence Abraham Flexner’s landmark review of American medical schools in 1910 on the PT education.3 It argues that physical therapy leaders’ focus on enhancing their profession’s status and indifference toward facilitating educational access and mobility played a significant role in the field’s racial homogeneity. It calls for PT education to move away from the Flexnerian model and pursue approaches that have helped more diverse and inclusive health professions, like nursing, to achieve greater educational opportunity and mobility.

Meals on Wheels (MoWs) is a crucial service delivering food to older adults, and adults with care and support needs, who might not be able to prepare their own meals. A recent study in Bristol sought to explore the experiences of service users and people who refer them to the service. The findings highlight that despite a variety of different referral routes, referrers who are family members are perceived as most likely to enquire about, and commence MoWs, for adults with care and support needs. The service was perceived as easy to commence, but there were several tensions identified, and existing preconceptions and stereotypes were perceived to act as barriers to accessing MoWs.4

Podcast of the month: Comedian and erstwhile GP, Phil Hammond, talks with guests about their medical careers in his usual amusing yet thoughtful way – well worth a listen.


  1. Horgan S, Drennan J, Andrews E, Saab MM, Hegarty J. Healthcare professionals’ knowledge and attitudes towards surgical site infection and surveillance: A quasi‐experimental study. Nursing Open. 2024 Jan;11(1):e2048.
  2. Martin FS, Gosse M, Whelan E. ‘Planning for a healthy baby and a healthy pregnancy’: A critical analysis of Canadian clinical practice guidelines for the treatment of opioid dependence during pregnancy. Sociology of Health & Illness. 2023 Oct 16.
  3. Hogan AJ. Accessibility in health professions education: The flexner report and barriers to diversity in American physical therapy. Social Science & Medicine. 2023 Dec 20:116519.
  4. Papadaki A, Wakeham M, Ali B, Armstrong ME, Willis P, Cameron A. Accessing Meals on Wheels: A qualitative study exploring the experiences of service users and people who refer them to the service. Health Expectations. 2024 Feb;27(1):e13943.

Featured image: Photo by Kevin Ku on Unsplash

The BJGP is the world-leading primary care journal. At BJGP Life we add multi-media comment and opinion for the primary care community.

Ahmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He also writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.

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